Monday, February 01, 2010

The Common Room

I started writing this post on Saturday in Roslindale. My last shift working in Boston.

Starting next Saturday I’ll be working on Medic 1 in Newton. It’ll be a slightly different point of view from working Medic 2 on Wednesdays because Medic 1 covers the southern half of the city. And my future partner is someone I’ve known for a number of years. He was one of the preceptors that I rode with when I was in Paramedic school. He’s a good medic, and he’s a character.

It will be interesting.

Some observations about the room… As I write this there are 8 of us hanging out right now. And there are a number of loud simultaneous conversations going on. It’s tough to write because of the cacophony, but it is fascinating listening to (and participating in) the noise of the room. Right now the threads include bashing nursing facilities, diabetics with gangrenous feet, and bad calls. Those are the ones I can cut through to sort out. And there is the inevitable patient bleeding from a fall. The nursing facility that is being described has a fish tank loaded with fish and nearly no water.

Go figure.

One of the guys in the room is just sitting there. He’s ignoring the chatter trying to watch Deadliest Catch. I don’t blame him; the cacophony is pretty loud…

On the overnight Saturday and into Sunday we were in and out of Newton a number of times. We got sent early Sunday morning for what we thought was another coverage trip but it turned out to be a trip to one of the three colleges in Newton. A 19 year-old male who’d been drinking – he walked into a wall and had a small abrasion on his forehead right above the bridge of his nose. The residence staff at his dorm got concerned and called 911. Fire went out and on the way asked for an ALS unit when a BLS unit was in the city covering. So we got sent from Roslindale and it took us 14 minutes to get from the base station to the scene. A bit of a problem when we have a maximum time of 9 minutes.

We got there and found the patient being interviewed by one of the firefighters. Patient had been drinking between 9:00P and Midnight. Total of 7 shots of rum. So by the time we’d gotten there he’d possibly metabolized about half of what he drank.

Surprisingly, he was alert, oriented, and walking. I assessed him from the top down: he denied a headache and I had negative findings when I assessed his skull. Pupils were equal and reactive to light with no pain associated with it. Cervical spine was solid with full range of motion. He had equal grips and full movement of his extremities.

My only concern was that he had a history of head injuries. He told me that with the concussions he’d had in the past were much, much worse than this “bump” he described. Between my partner and me, we tried for a little bit to convince him that he should at least be evaluated to ensure he had no further injury. Patient wouldn’t have any part of it.

In the end, I had no choice but to sign him off. He was fully aware of everything that was going on around him and he was considerably more articulate than any of us in the room were. And he couldn’t be forced to go. So – he stayed at his dorm room. But we at least were able to get the residence staff to keep an eye on him if anything changed.

Not that I’m complaining, but the BLS crew could definitely have handled this call.

Tonight I’m working with an old friend in Goffstown. It should be a good shift. At least I’m hoping so.


Michael said...

They(the EMD designers) refuse to let BLS do anything except falls and butt wiping.

TOTWTYTR said...

That's not the EMD designers responsibility. It's a matter of state, region, system protocol and ultimately the system medical director. If they abdicate their responsibility to some dumb card system, that's their fault.

Walt Trachim said...

The thing to remember with this is that it happens everywhere. It's not unique to the city of Newton. If you keep that in mind it makes it easier to keep the whole issue in perspective.

Walt Trachim said...
This comment has been removed by the author.
TOTWTYTR said...

The problem with EMD is that it is not designed to get the proper level of resources to a patient. It is designed to be reproducible and defensible in court. It's intended to make managers and medical directors more comfortable, nothing more.